CH13 Death and dying

Total brain dead: Irreversible loss of functioning in the entire brain, both the higher centres of

cerebral cortex that are involved in thought and the lower centres that control basic life

processing such as breathing

 Different systems of the body die at different rates

 Person must be totally unresponsive to stimuli

 Show no movement in response to noxious stimuli

 No reflexes such as constriction of eye pupil in response to light

 EEG should indicate an absence of electrical activity in cortex of brain

Euthanasia: Hastening either actively or passively, the death of someone suffering from an

incurable illness or injury; literally “good dead”

 Deliberately and directly causing the death of a person suffering

 Passive euthanasia: allowing terminally ill patients to die naturally or omitting

treatment that might otherwise sustain life

Assisted dying: Making available to ind who wish to die the means by which they may do so,

such as when a doctor provides terminally ill patients who wants to die with enough

medication to overdose

Living will: A document in which people state what healthcare steps should be taken or not in

certain circumstances of a person is in capacitated and cannot make the decision themselves:

also known active care directive

Life expectancy: The average number of years a newborn baby can be expected to live
  Female hormones protect from high blood pressure and heart problems and women

less likely die from violent death and accidents and to effects of smoking and drinking

 Indigenous ppl = lower

 Females: 84.4

 Males: 80.5

 Majority of deaths in early adults

 3.2 infant deaths per 1000 live births (double for abo)

 Top 3 killers – coronary heart disease, dementia-related diseases and cerebrovascular

diseases

 Infants

o Complications in period surrounding birth and congenital abnormalities

 Children and adolescence:

o Unintentional injuries ir accidents, cancer

 Middle aged adults

o Chronic diseases such as cardiovascular disease, accidents, suicide

 Older adults

o Chronic, mental and neurological diseases

Theories of aging

Programmed theories of aging: Theories of aging that emphasise the systematic genetic

control of aging processes

Damage/error theories of aging: Theories of aging that emphasise several haphazard

processes that cause cells and organ systems to deteriorate

Maximum life span: A celling on the number of years any member of a species lives
Hayflick limit: The limit to the number of times each cell of a certain species can divide

before cell death occurs

Telomere: A stretch of DNA that forms the tip of chromo and that shortens after each cell

division, possibly timing the death of cells

Damage or error of aging

Free radicals: Chemically unstable by-products of metabolism that have extra electron and

react with other molecules to produce toxic substances that damage cells and contribute to

aging

Antioxidants: Vit C and E and similar substances that may increase longevity to a degree by

inhibiting the free radical activity associated with oxidation and in turn preventing age-related

diseases

o Caloric restriction : A highly nutritious but severely calorie restricted diet of 60-70

per cent or less of normal total caloric intake may increase longevity

Experience of death

Perspective of dying – Kubler ross stages

o Denial and isolation: common first response to dreadful news is to say no it can’t be.

= defence mechanism in which anxiety provoking thoughts are kept out of or ‘isolated

from’ conscious awareness

o Anger: why me? Feelings of rage and resentment may be directed to anyone who is

handy

o Bargaining: when a dying person bargains, ok me but please. Begs for concession

from
 o Depression: As dying person becomes even more aware of the reality of the situation

depression, despair and sense of hopelessness

o Acceptance: If dying person is able to work through emotional reactions of the

preceding stages they may accept the inevitability of death in a calm and peaceful

manner

Problem with stages

o Emotional responses to the dying process are simply not stage-like. Although

dying patients often display symptoms of depression as a death nears, the other

emotional reactions ross described seems to affect only minorities of dying

people. When these responses occur, they do not unfold in standard order

Perspectives on bereavement

Bereavement: A state of loss that provides the occasion for grief and mourning

Grief: the emotional response to loss

Mourning: Culturally prescribed ways of displaying reactions to a loss

Anticipatory grief: Grieving before death for what is happening and for what lies ahead

Parkes-Bowlby attachment model of bereavement: Model of grieving describing four

predominant reactions to loss of attachment

1. Numbness: in the first few hours or days after the death the bereaved person if often is

a daze

2. Yearning: As a numbing sense of shock and disbelief diminishes, the bereaved person

experiences more agonising

 3. Disorganised and despair

4. Reorganisation

Duel process model of bereavement : A theory of coping with bereavement in with the

bereaved oscillate between loss-oriented coping. In which they deal with their emotions and

reconcile the loss; restoration-oriented coping, in which they manage practical tasks and

reorganise their lives; and period of respite from coping